DS-DE 12 Campaign Treasurer's Report G4-07r
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FLORIDA DEPARTMENT OF STATE DIVISION OF ELEC(jl~~f~~~r+~,~ ~~,.~lCF
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CAMPA
IGN TREASURE
R
S REPORT SUMMARY
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(~) mlAf111' l-X~(~ I1f~Sfb~IUTS i0 f1QOT~GT ~06)>rLL~UAX~ES N61f~ OFFICE USE ONLY
Name
Address (number and street)
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City, State, Zip Code
^ CHECK IF ADDRESS HAS CHANGED (3) ID Number: 2D- d 5'7 J 8'72
(4) Check appropriate box(es):
^ Candidate (office sought):
Political Committee ^ CHECK IF PC HAS DISBANDED
^ Committee of Continuous Existence ^ CHECK IF CCE HAS DISBANDED
^ Party Executive Committee
^ Electioneering Communication ^ CHECK IF NO OTHER ELECTIONEERING
COMMUNICATION REPORTS WILL BE FILED
(5) REPORT IDENTIFIERS
Cover Period: From ! - l p2 / O'7 To t r ~ 1 S ~ ~~ Report Type ~ L(
Original ^ Amendment ^ Special Election Report ^ Independent Expenditure Report
(6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT
Cash & Checks ~ l D, DDO ~ ~~ Monetary ~a
Expenditures $ ~,~ t ~.
Loans $ ~ Transfers to Office
Account $ --
Total Monetary $ Total
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Monetary $ - ~~E OQ~
In-Kind $
(8) Other Distributions
$ ""
(9)
TOTAL Monetary Contributions To Date (10) TOTAL Mon
ry Ex enditures To Date
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(11) CERTIFICATION
It is a first degree misdemeanor for any pers on to falsify a public record (ss. 839.13, F.S.)
I certify that I have examined this report and it is true, I certify that I have examined this report and it is true,
correct, and complete. correct, and complete.
(TYPe name) ~~fl~1~ ~p.$N1GK. CfYPe name) ~~r~C~} ~.PSIlJ1GK.
^ Individual (only for Treasurer ^ Deputy Treasurer ^ Candidate ®Chairperson (only for PC, PTY &
electioneerin ~r+ea,)- ertng mun. organization)
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Signature Sign e
DS-DE 12 (Rev. 08!04)
CAMPAIGN TREASURER'S REPORT -ITEMIZED CONTRIBUTIONS
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(1) Name IA ( ~ ( c ~ ~ p (2) I.D. Number ~- g57 I X72
I31 Cover Period -~ ~ / 17 ~ / (`~~ through ~) / l~S- / l~ -7 f4) Paae ' - of
(5)
Date (~)
Full Name (8) (9) (1 ~) (1 ~) (12)
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
Cit ,State, Zi Code
Contributor
T e Occu ation
Contribution
T e
In-kind
Descri tion
Amendment
Amount
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DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCT[ONS AND CODE VALUES
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1.
C~jM~ ~PAtG,~j~TREASURER'S REPgR__T -ITEMIZED EXPENDITURES
(1) Name ~1AM4 [~I~AG~'I /(~SI.DfXF~S ~-o P~~,Fa?r ffDM~1~,t.1P9P.E~S~~~,(2) I.D. Number ~ - ~~~~~7~.
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(3) Cover Period ~/~!~ through ~/ ~-S / ~~ (4) Page ~ of
(5)
Date (7)
Full Name (8)
Purpose (9) {10) (11)
(6)
Sequence
Number (Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code (add office sought if
contribution to a
candidate)
Expenditure
TYPe
Amendment
Amount
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DS-DE 14 {Rev. 08!03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES